A MEDICAL PROBLEM THAT WON’T GO AWAY
Robert—our daughter Stacy’s husband—and I were standing quietly outside the double doors that led to the medical center’s intensive care unit (ICU). It was early in the morning and Stacy was inside the unit on a respirator. The doors were closed. We had been asked to leave while the nurses took care of the patients.
A group of white-jacketed residents were walking down the long hallway toward us. Someone in that crowd had told a joke and they started laughing. As they came closer the bantering back and forth grew louder. A few of the residents glanced at Robert and me as they passed by but that didn’t stop their noisy voices. Finally, the ICU’s doors opened and then closed behind them.
Robert and I looked at each other. What was wrong with them? How could young doctors, moving into their shift in the ICU, be so thoughtless? They saw us standing next to the doors and must have known we had someone in ICU, someone we loved. And then I heard Robert say, “I hate those guys.” I knew just what he meant.
Stacy, suffering from breast cancer, had recurred more and more often during the course of her illness and was at the medical center for the last time with fluid in her lungs. Over the five days, when she had been rushed into the ICU, my husband Ed, Robert and I slept on the floor of the waiting room. There were no beds or lounge chairs available but several of the nurses had given us pillows and blankets. We thanked them but it didn’t matter to us. We rarely slept those five nights anyway.
We lost Stacy on day six.
A year or so later, Ed and I were invited to the medical center to talk about some of our experiences. Once in the conference room, we took our seats along with some other folks there for the same reason and, when the moderator turned to us, I spoke about them . . . that group of shrill residents making their rounds that night.
After the meeting and just before Ed and I were leaving the hospital for home, I saw the residents milling about outside the room. I walked over, planning on saying something that would, hopefully, take the sting out of my words. I got as far as “Hi–”, when one of the residents said to me without any preamble, “You know, we work very hard and have a lot of medical expectations to live up to. We need fun where we can get it.” I looked at him and then I walked away. There was no sense in starting an argument I couldn’t win. After all, I was merely a patient’s mother.
But I am also a medical sociologist and believe that doctors of all specialties have a responsibility to their patients, clinical as well as emotional. If a patient is unresponsive, as was our daughter, that responsibility should be transferred to the proxy, i.e., a family member, a close friend or a social worker.
I also know that, personally and professionally, all doctors are different in knowledge and in communicative expertise. They are human beings and have the same failings that many of us have. I know that.
But . . . there is research that points to an ongoing and long-established problem.
For example, an older study regarding medical malpractice and published in 1975 by David Mechanic, Director of the Center for Medical Sociology and Health Services Research, University of Wisconsin, suggested those deeper issues. Based on 1,017 interviews, he found a subgroup that reported doctors maintained poor doctor-patient relationships [because] . . . “they are too interested in money, they are less accommodating and more difficult to reach, and they are more impersonal or inconsiderate.” Later studies, from 2007 on, about the doctor-patient relationship found that in a number of cases they [doctors] lacked warmth and friendliness as well as an inability to bother with the patient’s concerns and expectations.
In addition, two recent books, with titles that tell clearly of this concern stand out: Treating the Ailing Doctor-Patient Relationship (2014) and Putting Humanity and the Humanities Back Into Medicine (2015).
And most telling, in the January 7, 2016 New York Times, in a review of the book When Breath Becomes Air the author, 37-year-old neurosurgeon Paul Kalanithi, was quoted as saying, “ . . . when the oncologist is away, he [Dr. Kalanithi] is treated as a problem and not a patient by an inexpert medical resident . . . .” At the time, Dr. Kalanithi was fatally ill with metastatic lung cancer.
With all the interest today in health issues by patients and their families many of these problems should have disappeared. Yet that’s not the case. The medical residents and their behavior that December night in front of my son-in-law and me falls right in the middle of this area.
Relational interaction with the patient is an integral part of a doctor’s job. And doctors, to be adequately trained, require a holistic medical education that goes beyond knowledge of clinical terms, illness symptoms, diagnoses and treatment. The interaction between doctor and patient is key. Nevertheless, it is left out more times than not.
Most medical students can and do receive early training in their medical school curriculum regarding doctor-patient relationships. Some researchers find, however, that while these young students are patient-centered in their outlook, when they move forward in their medical career they become less so. By the fourth year, they have become ” . . . more doctor-centered or paternalistic.” In other words, getting to know their patients becomes less of an issue. Science is foremost, I know, but the humanistic part of medicine is fundamental as well.
Since patients now have access to the internet and the relevant knowledge gleaned from that entity what, I still wonder, fosters medical student and doctor attitudes, both good and bad, toward their patients? I believe that it is imperative to find out.
For full transparency: Suzann B. Goldstein was a PhD student in medical sociology at Rutgers, The State University of New Jersey. Her dissertation topic: Doctor-Patient-Proxy Relationships!